Provider Demographics
NPI:1750430823
Name:STESIN, MARK PHILLIP (MD)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:PHILLIP
Last Name:STESIN
Suffix:
Gender:
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:3366 OAKDALE AVE N STE 409
Mailing Address - Street 2:
Mailing Address - City:ROBBINSDALE
Mailing Address - State:MN
Mailing Address - Zip Code:55422-2948
Mailing Address - Country:US
Mailing Address - Phone:763-582-1800
Mailing Address - Fax:763-582-1860
Practice Address - Street 1:3366 OAKDALE AVE N STE 409
Practice Address - Street 2:
Practice Address - City:ROBBINSDALE
Practice Address - State:MN
Practice Address - Zip Code:55422-2948
Practice Address - Country:US
Practice Address - Phone:763-582-1800
Practice Address - Fax:763-582-1860
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-09
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN26308207RE0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RE0101XAllopathic & Osteopathic PhysiciansInternal MedicineEndocrinology, Diabetes & Metabolism
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN411553229OtherSELECTCARE MINNESOTA
WI30708700OtherWISCONSIN MEDICAID
MN525375600Medicaid
MNDD1669OtherRAILROAD MEDICARE
MN1004632OtherPREFERRED ONE
MN87857STOtherBLUE CROSS MN INDIVIDUAL
MN87857STOtherCOMPREHENSIVE CARE
MN100194OtherUCARE MINNESOTA
MNED0201OtherAMERICAS PPO
MNHP14484OtherHEALTHPARTNERS
MNNO10118OtherCHAMPUS
MNHP14484OtherHEALTHPARTNERS
MNNO10118OtherCHAMPUS